Q&A: Julie Silver, MD

Julie Silver, MD

In a recently published First Opinion piece in STAT News, Julie Silver, MD, described her work studying the gender of medical society award recipients. Her goal is to gain an understanding of what it says about women in medicine and how they navigate the medical society landscape, which is often part of the path to career advancement. Silver and her colleagues also launched a #SocietiesAsAllies hashtag on Twitter to continue the conversation and engage medical societies. Silver is an associate chair of the Department of Physical Medicine and Rehabilitation with appointments at BWH, Spaulding Rehabilitation Center and Massachusetts General Hospital. She recently spoke with CRN about her research, goals and what inspired her to delve into the data.

How did you become interested in this area of study?

JS: One of the things I began focusing on when I became associate chair of the Department of Physical Medicine and Rehabilitation was how to support our faculty and the work that they do. We have more than 80 faculty members, most of whom are physicians, but there are also some PhDs. And more than 60 percent of them come from underrepresented groups. I saw some of the challenges that our faculty members faced, especially regarding promotions at the medical school, leadership opportunities, new positions, increased pay and so on.

What I realized is that there are some barriers for members of underrepresented groups that do not exist for others. And that led me to create Project ValYou. This project looks at how we value our faculty members, how they are valued by others and how we value our patients as well as our colleagues. One of the initiatives that was part of this project was to look at how medical societies value our faculty.

What explains the disparities that underrepresented groups in medicine face when it comes to career advancement?

JS: The way I look at is that there are three major gatekeepers. A lot of research has focused on two of those gatekeepers: institutional leaders and national funding agencies. But there is another important gatekeeper: the medical societies.

When I began looking at the data, I realized that our faculty needed equitable support from all of these gatekeepers, but especially medical societies. Many of the things that they need to have on their curriculum vitae in order for the promotions committee at Harvard Medical School to promote them or for faculty to be considered for leadership positions within Partners are various accomplishments they would achieve at the medical society level. I realized that there needed to be some research and some data that was published looking at how equitably medical societies are supporting their members.

What was your goal in analyzing the number of medical society recognizing awards given to women and minorities?

JS: My goal is to create a tipping point by demonstrating at least one significant macroinequity at the medical society level. To identify something that health care leaders understand and would be difficult to ignore. A recognition award generally isn’t given for a single accomplishment, but rather for a series of accomplishments. And those same types of accomplishments are the things that people need for promotion at the medical school.

I wanted to use a rubric to measure not just whether faculty can join the medical society – that would be a measure of diversity – but rather would they be able to navigate the medical society and be successful at accessing its resources equitably. That’s a measure of inclusion.

What did you find?

The first study that we published was on just one society for the field of physical medicine and rehabilitation. And in that study, we found that women physicians had been underrepresented for almost half a century, and that it really couldn’t be explained by pipeline issues, which is a common go-to thought that people have. About a third of the physicians in the specialty of physical medicine and rehabilitation are women. Women were specifically underrepresented in the most prestigious award categories, particularly the lectureships. In 40 of the 48 years, women were not given lectureship awards. The second step was to show that this wasn’t simply one rogue medical society, that it was systemic in the specialty.

Therefore, we looked at another medical society in the same specialty. Somewhat surprisingly, we found even more striking results than in the first society we studied. We found that in the past four years that we studied, no woman physician had received a recognition award in any category. And we found that during the past 10 years, no woman physician had won a recognition award in 50 percent of the categories that we studied.

As we expanded our work, we began using a concept we call the “inexorable zero.” Zeroes are important – for instance, in a category where no women have received an award this year – but so are the numbers that are extremely close to zero – for instance, in a category where just one or two women have received an award in the last several decades. They point to areas that cry out for further investigation. Using the inexorable zero concept, we aimed to show that a marked lack of recognition was not limited to one specialty but rather was a more systemic problem in medicine. So, in a third report we found examples of zero or near-zero representation of women physicians among recognition award recipients in dermatology, neurology, anesthesiology, orthopaedic surgery, head and neck surgery, and plastic surgery. This wasn’t an exhaustive study; we believe that other specialties have similar gender gaps.

What are you hoping will be accomplished by publishing these data?

JS: We want to encourage medical societies to look at their diversity and inclusion data, including but not limited to recognition awards. Many people have become immune to seeing mostly male physicians’ work featured in newsletters and on websites, and mostly men physicians as award recipients or plenary/keynote speakers. And, frankly, that’s problematic. We think data are the best way to bring this to light. The only way to really try to be as equitable as possible is to routinely look at the data and focus on areas where there are problems. My stance is that we should give the medical societies an opportunity to look at their data and to take ownership of disparities. And continue to support them through this process. Because the more we talk about it, and use data to drive decision-making, the more likely change is going to happen.